重度主动脉瓣狭窄合并二尖瓣反流——来自CURRENT AS注册研究的报告
Concomitant Mitral Regurgitation in Severe Aortic Stenosis - A Report From the CURRENT AS Registry.
作者信息
Murai Ryosuke, Kawase Yuichi, Taniguchi Tomohiko, Morimoto Takeshi, Kadota Kazushige, Ohya Masanobu, Shimada Takenobu, Maruo Takeshi, Fuku Yasushi, Komiya Tatsuhiko, Ando Kenji, Hanyu Michiya, Kanamori Norio, Aoyama Takeshi, Murata Koichiro, Onodera Tomoya, Yamazaki Fumio, Kitai Takeshi, Furukawa Yutaka, Koyama Tadaaki, Miyake Makoto, Izumi Chisato, Nakagawa Yoshihisa, Yamanaka Kazuo, Mitsuoka Hirokazu, Shirotani Manabu, Kato Masashi, Miki Shinji, Nakajima Hiroyuki, Hirano Yutaka, Miyazaki Shunichi, Saga Toshihiko, Sugioka Sachiko, Matsuda Shintaro, Matsuda Mitsuo, Ogawa Tatsuya, Nagao Kazuya, Inada Tsukasa, Nakayama Shogo, Mabuchi Hiroshi, Takeuchi Yasuyo, Sakamoto Hiroki, Sakaguchi Genichi, Yamane Keiichiro, Eizawa Hiroshi, Toyofuku Mamoru, Tamura Takashi, Iwakura Atsushi, Ishii Mitsuru, Akao Masaharu, Shiraga Kotaro, Minamino-Muta Eri, Kato Takao, Inoko Moriaki, Ueyama Koji, Ikeda Tomoyuki, Himura Yoshihiro, Komasa Akihiro, Ishii Katsuhisa, Hotta Kozo, Sato Yukihito, Fujiwara Keiichi, Kato Yoshihiro, Kouchi Ichiro, Inuzuka Yasutaka, Ikeguchi Shigeru, Miwa Senri, Maeda Chiyo, Shinoda Eiji, Nishizawa Junichiro, Jinnai Toshikazu, Higashitani Nobuya, Kitano Mitsuru, Morikami Yuko, Kitaguchi Shouji, Minatoya Kenji, Kimura Takeshi
机构信息
Department of Cardiology, Kurashiki Central Hospital.
Division of Cardiology, Kokura Memorial Hospital.
出版信息
Circ J. 2022 Feb 25;86(3):427-437. doi: 10.1253/circj.CJ-21-0054. Epub 2021 Jul 16.
BACKGROUND
The clinical significance of concomitant mitral regurgitation (MR) has not been well addressed in patients with severe aortic stenosis (AS).
METHODS AND RESULTS
We analyzed 3,815 patients from a retrospective multicenter registry of severe AS in Japan (CURRENT AS registry). We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategy (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death or heart failure hospitalization. At baseline, moderate/severe MR was present in 227/1,197 (19%) patients with initial AVR strategy and in 536/2,618 (20%) patients with a conservative strategy. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR, regardless of the initial treatment strategy (25.2% vs. 14.4%, P<0.001 in the initial AVR strategy, and 63.3% vs. 40.7%, P<0.001 in the conservative strategy). After adjusting confounders, moderate/severe MR was not independently associated with higher risk for the primary outcome measure in the initial AVR strategy (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.67-1.83, P=0.69), and in the conservative strategy (HR 1.13, 95% CI 0.93-1.37, P=0.22).
CONCLUSIONS
Concomitant moderate/severe MR was not independently associated with higher risk for the primary outcome measure regardless of the initial treatment strategy.
背景
在严重主动脉瓣狭窄（AS）患者中，二尖瓣反流（MR）的临床意义尚未得到充分探讨。
方法与结果
我们对日本一项严重AS的回顾性多中心注册研究（CURRENT AS注册研究）中的3815例患者进行了分析。根据初始治疗策略（初始主动脉瓣置换术[AVR]或保守策略），我们比较了中度/重度MR患者与无/轻度MR患者的临床结局。主要结局指标是主动脉瓣相关死亡或心力衰竭住院的复合指标。基线时，227/1197（19%）例初始采用AVR策略的患者和536/2618（20%）例采用保守策略的患者存在中度/重度MR。无论初始治疗策略如何，中度/重度MR患者的主要结局指标的粗累积5年发生率均显著高于无/轻度MR患者（初始AVR策略中分别为25.2%对14.4%，P<0.001；保守策略中分别为63.3%对40.7%，P<0.001）。在调整混杂因素后，中度/重度MR在初始AVR策略（风险比[HR]1.11，95%置信区间[CI]0.67 - 1.83，P = 0.69）和保守策略（HR 1.13，95%CI 0.93 - 1.37，P = 0.22）中均与主要结局指标的较高风险无独立相关性。
结论
无论初始治疗策略如何，合并中度/重度MR均与主要结局指标的较高风险无独立相关性。
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